Published in the March 2019 issue of Today’s Hospitalist
IF YOU’RE LOOKING for a surefire way to observe this year’s World Sepsis Day (Sept. 13), you may want to take a page from Philadelphia’s Penn Presbyterian Medical Center. Last year, the hospital marked that occasion by staging an escape room for clinicians and staff. That event was designed to raise awareness about sepsis and educate participants not only about sepsis treatments, but the need for speed when delivering them.
While the target audience for the event was nurses, nursing aides and nursing students, “it’s important to include the entire team—and when I say ‘the entire team,’ I mean everybody in the hospital,” says Paula Gabriel, MSN-RN, a clinical nurse educator who helped organize the event. “We have people working in environmental services who come out of rooms after cleaning them and mention to a nurse, ‘That patient is breathing fast.’ So everyone plays a role in promoting sepsis awareness.”
Better than a lecture
When it comes to sepsis, nurses on busy medical units may not be aware that they need to treat a sepsis diagnosis as the emergency it is. Also, because suspected sepsis comes with a flurry of orders, nurses may not understand the importance of having all those orders filled at the same time—or be aware of the sequence of interventions called for after a sepsis diagnosis.
“I wanted to create something that was interactive and fun at the same time.”
~ Lauren McPeake, RN
Penn Presbyterian Medical Center
At Penn Presbyterian, the success of last year’s escape room was built on one staged the previous year in the hospital’s acute care of the elderly (ACE) unit. That earlier effort was put together by Lauren McPeake, RN, a staff nurse on that unit who used to work in the ED.
Why the idea of an escape room? “They were starting to be very popular and popping up all over the place,” says Ms. McPeake. Plus, she doesn’t really learn much “from being lectured at. I don’t retain a lot of information that way, so I wanted to create something that was interactive and fun at the same time.”
In planning the hospital-wide escape room staged in September 2018, Ms. Gabriel and Ms. McPeake were joined by Casey Lieb, MSN-RN, also a clinical nurse educator. Both Ms. Gabriel and Ms. Lieb are members of the Penn Sepsis Alliance and its educational and communications workgroup, which is charged with developing strategies to help providers quickly recognize and treat sepsis. In addition, each hospital in the Penn Medicine system has its own sepsis committee.
For their escape room, the three nurses and members of the hospital’s sepsis committee decided to present a clinical sepsis scenario, giving participants a series of puzzles they’d need to solve within 25 minutes. They devised the puzzles themselves, and Ms. Lieb estimates that they each spent about 30 hours planning the event in the four months leading up to it. With support from nursing leadership, project members were able to turn a conference room into an escape room. They were also given time for a dry-run before the actual event “to make sure the puzzles weren’t too easy or too hard,” says Ms. Lieb.
A series of puzzles
Participants were encouraged to sign up ahead of time, and escape room sessions were staged between 5 a.m. and 2 p.m. to allow overnight clinicians and staff to participate. Photos of groups who successfully escaped (and the few that didn’t) were posted to the hospital’s internal Facebook page over the course of the day to raise visibility and push participation. The alliance ended up having to stage the event again one day in October to accommodate everyone who wanted to participate.
“Participants had to figure out which antibiotics the patient in our clinical scenario needed to receive.”
~ Casey Lieb, MSN-RN
Penn Presbyterian Medical Center
Ms. Lieb declines to describe all the puzzles used, saying they plan to write up event results themselves for publication. She does note that puzzles entailed cryptograms and riddles, and she describes the one she believes was the hardest to solve.
“We had an IV pole set up with multiple antibiotics and other IV medications,” she explains. “Participants had to use a compatibility chart on the wall and other tools in the room to figure out which antibiotics the patient in our clinical scenario needed to receive.” The information the puzzle was designed to convey was this: “When treating sepsis, you need to hang antibiotics simultaneously instead of one at a time. We also wanted participants to recognize the different antibiotics that could be ordered for sepsis.”
Event organizers also decided to stay in the escape room with each group. “At first, us being there may have made some participants a little uncomfortable,” says Ms. Gabriel. “But we allowed each group to ask us two questions to help them solve the puzzles.”
And when a group got stuck on one of the puzzles, “we’d tell them to think together out loud, then we tried to lead them in the right direction,” she adds. Staying in the escape room also taught the organizers two key lessons.
One, it’s important to limit each participating group to no more than eight. And “some participants would shy away from actively contributing while more dominant personalities would talk over others,” says Ms. Gabriel. Once participants solved all the puzzles (or their 25-minute limit was reached), the organizers in the room would debrief them and point out those team dynamics. They also used that time to tell participants about the hospital’s internal sepsis resources and stress the importance of educating sepsis patients and their families at discharge on how to recognize symptoms of recurrence.
“I’ve since witnessed first-hand nurses implementing strategies that we taught them.”
~ Paula Gabriel, MSN-RN
Penn Presbyterian Medical Center
Sepsis committee members at the hospital are already planning an encore escape room for this coming September. They’re also thinking of ways to use the same concept to educate staff and clinicians about treating other diseases in the hospital, including diabetes.
And it’s been gratifying, Ms. Gabriel says, to see nurses—when treating actual sepsis patients—successfully using interventions staged in the escape room. “I know who went through the escape room,” she says, “and I’ve since witnessed first-hand nurses implementing strategies that we taught them.”
Phyllis Maguire is Executive Editor of Today’s Hospitalist.